1
|
Mitrogiannis L, Mitrogiannis G, Melaki K, Karamitros A, Karantanas A, Paxinos O. An Early Functional Unsupervised Rehabilitation Protocol Allows Safe Return to Function After Achilles Tendon Repair. Cureus 2024; 16:e52477. [PMID: 38371156 PMCID: PMC10873818 DOI: 10.7759/cureus.52477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE Acute Achilles tendon tears in young active individuals are often treated surgically with prolonged rehabilitation, with the leg initially immobilized in plantar flexion in serial non-weight bearing casts and gradually progressing to full weight bearing. This study aimed to evaluate the safety of an early functional unsupervised rehabilitation protocol. METHODS The medical records of 25 patients treated with open repair were available for follow-up. In 10 patients, an early functional unsupervised rehabilitation protocol was used with a removable cast, active range of motion exercises of the ankle from the first postoperative day, and full weight bearing in a walking boot with the foot plantigrade after the second week. Another 15 patients who followed the classic rehabilitation protocol were used as controls. The patients were evaluated with the Victorian Institute of Sports Assessment-Achilles (VISA-A) and an ultrasound examination-based score. A Wilcoxon test was used to compare the scores between the groups. RESULTS The mean VISA-A score was 90.1 (SD = 9.87) for the early functional rehabilitation protocol group, while it was 83.8 (SD = 17.06, p = 0.624) for the control group. The mean ultrasound score was 7.75 (SD = 1.71) for the early functional rehabilitation protocol group, while it was 7.60 (SD = 3.05, p = 0.414) for the control group. There were no intra- or early postoperative complications in the groups, and all patients were satisfied with the results of their operation. CONCLUSIONS An early unsupervised functional rehabilitation protocol after open Achilles repair may allow for safe early mobilization and minimize the need for physiotherapy. The small number of participants is a limitation of this study, and further evaluation with more patients is necessary to document the efficacy.
Collapse
Affiliation(s)
| | - George Mitrogiannis
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Kalliopi Melaki
- Radiology Department, General Hospital of Piraeus "Tzaneio", Athens, GRC
| | | | | | - Odysseas Paxinos
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
| |
Collapse
|
2
|
Nilsson N, Alim MDA, Dietrich-Zagonel F, Concaro S, Brorsson A, Nilsson Helander K, Eliasson P. The Delayed Presentation of Achilles Tendon Ruptures Is Associated With Marked Alterations in the Gene Expression of COL1A1, MMPs, TIMPs, and IL-6. Am J Sports Med 2024; 52:164-173. [PMID: 38164679 DOI: 10.1177/03635465231212669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Both acute and chronic Achilles tendon ruptures are affected by alterations in the extracellular matrix during the healing process of the tendon. Yet, these alterations in gene expression patterns are not well characterized. PURPOSE To characterize temporal and spatial differences in gene expression patterns after an Achilles tendon rupture and to evaluate if cells from chronic Achilles tendon ruptures have the same ability to form new tendon tissue (tendon constructs) as healthy tendon cells. STUDY DESIGN Controlled laboratory study. METHODS A total of 35 patients with surgically treated Achilles tendon ruptures were included in the study and divided into 3 groups: acute (<4 weeks), short-term chronic (1-6 months), and long-term chronic (>6 months). Biopsy specimens were collected during surgical repair and were used to analyze the gene expression within the different groups and to compare mRNA levels in the proximal and distal tendon ends. A complementary in vitro experiment was performed to evaluate if cells from chronic Achilles tendon ruptures can form tendon constructs. RESULTS The mRNA levels for COL1A1 and COL3A1 were significantly higher in the short-term chronic group compared with the acute group (P < .05). Both MMP-1 and MMP-13 had the highest mRNA levels in the acute group (P < .01) compared with the long-term chronic group, while MMP-2 had the highest mRNA level in the short-term chronic group. Significant differences between the proximal and distal tendon ends were only detected for the monocyte and macrophage marker CD163 (P < .05), which was more expressed proximally. Cells extracted from chronic Achilles tendon ruptures displayed a similar ability and effectiveness to form tendon constructs as healthy tendon cells. CONCLUSION A high collagenase gene activity after an Achilles tendon rupture indicated possible rapid matrix degradation in the acute phase. Chronic ruptures appeared to initiate the healing process even before treatment, indicated by the higher expression of collagen in the short-term chronic group. Cells from chronic Achilles tendon ruptures also displayed an ability to form new tendon tissue in vitro. CLINICAL RELEVANCE The study shows a rapid increase in collagenase gene expression, which could lead to matrix degradation that continues for months after an Achilles tendon rupture.
Collapse
Affiliation(s)
- Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - M D Abdul Alim
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Franciele Dietrich-Zagonel
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sebastian Concaro
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- IFK Kliniken Rehab, Gothenburg, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Pernilla Eliasson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Nilsson N, Stensöta I, Nilsson Helander K, Brorsson A, Carmont MR, Concaro S. Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures - a systematic review. BMC Musculoskelet Disord 2023; 24:951. [PMID: 38066531 PMCID: PMC10704635 DOI: 10.1186/s12891-023-07064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft. METHODS A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS). RESULTS Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2-13) for all studies. CONCLUSION Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden.
| | - Immanuel Stensöta
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- IFK Kliniken Rehab, Gothenburg, Sweden
| | - Michael R Carmont
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Shropshire, UK
| | - Sebastian Concaro
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden
| |
Collapse
|
4
|
Kokulu K, Altunok İ, Sert ET, Özdemir S, Mutlu H, Akça HŞ. Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture. Foot Ankle Spec 2023; 16:384-391. [PMID: 36036526 DOI: 10.1177/19386400221118496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. METHODS This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain. RESULTS Kager's fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings. CONCLUSION Clinicians should be particularly aware of Kager's fat pad sign when examining lateral ankle radiographs for ankle injury. LEVELS OF EVIDENCE Level IV: Case control study.
Collapse
Affiliation(s)
- Kamil Kokulu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - İbrahim Altunok
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Serdar Özdemir
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Hatice Şeyma Akça
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
5
|
Prado MP, Mendes AAM, Nishikawa DRC, Saito GH. Inadequate Purchase in the Proximal Tendon Stump Using the Percutaneous Achilles Repair System: A Technical Tip. Foot Ankle Spec 2023; 16:402-405. [PMID: 36113026 DOI: 10.1177/19386400221119999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Minimally invasive approaches for the Achilles tendon have emerged as viable alternatives for acute Achilles ruptures, with several potential benefits in comparison to the open approach. Occasionally, proper purchase in the proximal tendon stump is not achieved due to severe degenerative disease of the tendon. In this article, we present a technique in which a small accessory incision is used during percutaneous Achilles repair in order to pass the sutures in a more proximal and healthy area of the tendon. This technique is useful for situations in which adequate tendon grasp is not obtained, avoiding the need of conversion to an open approach.Level of Evidence: Level V: Expert opinion.
Collapse
Affiliation(s)
- Marcelo P Prado
- Department of Orthopaedics, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alberto A M Mendes
- Department of Orthopaedics, Hospital Sírio Libanês, Advanced Medical Center, São Paulo, SP, Brazil
| | - Danilo R C Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Guilherme H Saito
- Department of Orthopaedics, Hospital Sírio Libanês, Advanced Medical Center, São Paulo, SP, Brazil
| |
Collapse
|
6
|
Adam NC, Smith CR, Herzog W, Amis AA, Arampatzis A, Taylor WR. In Vivo Strain Patterns in the Achilles Tendon During Dynamic Activities: A Comprehensive Survey of the Literature. SPORTS MEDICINE - OPEN 2023; 9:60. [PMID: 37466866 DOI: 10.1186/s40798-023-00604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Achilles' tendon (AT) injuries such as ruptures and tendinopathies have experienced a dramatic rise in the mid- to older-aged population. Given that the AT plays a key role at all stages of locomotion, unsuccessful rehabilitation after injury often leads to long-term, deleterious health consequences. Understanding healthy in vivo strains as well as the complex muscle-tendon unit interactions will improve access to the underlying aetiology of injuries and how their functionality can be effectively restored post-injury. The goals of this survey of the literature with a systematic search were to provide a benchmark of healthy AT strains measured in vivo during functional activities and identify the sources of variability observed in the results. Two databases were searched, and all articles that provided measured in vivo peak strains or the change in strain with respect to time were included. In total, 107 articles that reported subjects over the age of 18 years with no prior AT injury and measured while performing functional activities such as voluntary contractions, walking, running, jumping, or jump landing were included in this review. In general, unclear anatomical definitions of the sub-tendon and aponeurosis structures have led to considerable confusion in the literature. MRI, ultrasound, and motion capture were the predominant approaches, sometimes coupled with modelling. The measured peak strains increased from 4% to over 10% from contractions, to walking, running, and jumping, in that order. Importantly, measured AT strains were heavily dependent on measurement location, measurement method, measurement protocol, individual AT geometry, and mechanical properties, as well as instantaneous kinematics and kinetics of the studied activity. Through a comprehensive review of approaches and results, this survey of the literature therefore converges to a united terminology of the structures and their common underlying characteristics and presents the state-of-knowledge on their functional strain patterns.
Collapse
Affiliation(s)
- Naomi C Adam
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, and Berlin School of Movement Science, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| |
Collapse
|
7
|
Yang S, Shi W, Yan W, Ao Y, Guo Q, Yang Y. Comparison between primary repair and augmented repair with gastrocnemius turn-down flap for acute Achilles tendon rupture: a retrospective study with minimum 2-year follow-up. BMC Musculoskelet Disord 2023; 24:163. [PMID: 36871017 PMCID: PMC9985193 DOI: 10.1186/s12891-023-06260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND To explore and compare the clinical outcomes in patients undergoing primary repair versus augmented repair with a gastrocnemius turn-down flap for acute Achilles tendon rupture. METHODS From 2012 to 2018, the clinical data of 113 patients with acute Achilles tendon rupture who were treated with primary repair or augmented repair with a gastrocnemius turn-down flap by the same surgeon were retrospectively reviewed. The patients' preoperative and postoperative scores on the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society Ankle⁃Hindfoot (AOFAS) score, the Victorian Institute of Sport Assessment⁃Achilles (VISA-A), the Achilles tendon total rupture score (ATRS), and the Tegner Activity Scale were examined and compared. The postoperative calf circumference was measured. A Biodex isokinetic dynamometer was used to evaluate the plantarflexion strength on both sides. The time to return to life and exercise as well as the strength deficits in both groups were recorded. Finally, the correlation analyses between patient characteristics and treatment details with clinical outcomes were conducted. RESULTS In total, 68 patients were included and completed the follow-up. The 42 and 26 patients who were treated with primary repair and augmented repair were assigned to group A and B, respectively. No serious postoperative complications were reported. No significant between-group differences in any outcomes were observed. It was found that female sex was correlated with poorer VISA-A score (P = 0.009), complete seal of paratenon was correlated with higher AOFAS score (P = 0.031), and short leg cast was correlated with higher ATRS score (P = 0.006). CONCLUSIONS Augmented repair with a gastrocnemius turn-down flap provided no advantage over primary repair for the treatment of acute Achilles tendon rupture. After surgical treatment, females tended to had poorer outcomes, while complete seal of paratenon and short leg cast contributed to better results. LEVEL OF EVIDENCE Cohort study; Level of evidence, 3.
Collapse
Affiliation(s)
- Shuai Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China.
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China.
| |
Collapse
|
8
|
Crook BS, Varshneya K, Meyer LE, Anastasio A, Cullen MM, Lau BC. Operative Versus Nonoperative Treatment of Acute Achilles Tendon Rupture: A Propensity Score-Matched Analysis of a Large National Dataset. Orthop J Sports Med 2023; 11:23259671231152904. [PMID: 36874053 PMCID: PMC9974620 DOI: 10.1177/23259671231152904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 03/02/2023] Open
Abstract
Background No consensus exists regarding the superiority of operative versus nonoperative management for Achilles tendon ruptures, as multiple randomized controlled trials conducted since the advent of early mobilization protocols have found outcomes for these 2 interventions to be more similar than were previously held. Purpose To use a large national database to (1) compare reoperation and complication rates between operative and nonoperative treatment of acute Achilles tendon ruptures and (2) evaluate trends in treatment and cost over time. Study Design Cohort study; Level of evidence, 3. Methods The MarketScan Commercial Claims and Encounters database was used to identify an unmatched cohort of 31,515 patients who sustained primary Achilles tendon ruptures between 2007 and 2015. Patients were stratified into operative and nonoperative treatment groups, and a propensity score-a matching algorithm-was used to establish a matched cohort of 17,996 patients (n = 8993 per treatment group). Reoperation rates, complications, and aggregate treatment costs were compared between groups with an alpha level of .05. A number needed to harm (NNH) was calculated from the absolute risk difference in complications between cohorts. Results The operative cohort experienced a significantly larger total number of complications within 30 days of injury (1026 vs 917; P = .0088). The absolute increase in cumulative risk was 1.2% with operative treatment, which resulted in an NNH of 83. Neither 1-year (1.1% [operative] vs 1.3% [nonoperative]; P = .1201) nor 2-year reoperation rates (1.9% [operative] vs 2% [nonoperative]; P = .2810) were significantly different. Operative care was more expensive than nonoperative care at 9 months and 2 years after injury; however, there was no difference in cost between treatments at 5 years. Before matching, the rate of surgical repair for Achilles tendon rupture remained stable, from 69.7% to 71.7% between 2007 and 2015, indicating little change in practice in the United States. Conclusion Results indicated no differences in reoperation rates between operative and nonoperative management of Achilles tendon ruptures. Operative management was associated with an increased risk of complications and higher initial costs, which dissipated over time. Between 2007 and 2015 the proportion of Achilles tendon ruptures managed operatively remained similar despite increasing evidence that nonoperative management of Achilles tendon rupture may provide equivalent outcomes.
Collapse
Affiliation(s)
- Bryan S Crook
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Kunal Varshneya
- Stanford University School of Medicine, Stanford, California, USA
| | - Lucy E Meyer
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Albert Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Mark M Cullen
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| |
Collapse
|
9
|
Xu L, Jin J, Liu Z, Wu M, Peng B, Jiang J, Liu G, He J, White S, Xia Y. A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study. Orthop Surg 2022; 15:517-524. [PMID: 36573277 PMCID: PMC9891928 DOI: 10.1111/os.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Percutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure. METHODS Data of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive-combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner-Lindholm scale (A-L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2-year follow-up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded. RESULTS Twenty consecutive subjects with an average follow-up of 28.3 ± 4.5 months (range, 24-41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20-44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28-71) preoperatively to 97.8 ± 3.34 (range, 87-100) at the last follow-up. The A-L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10). CONCLUSIONS The results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.
Collapse
Affiliation(s)
- Lihu Xu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jiaxin Jin
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Zhongcheng Liu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Meng Wu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Bo Peng
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jin Jiang
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Guangyao Liu
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou University Second Hospital, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial IntelligenceLanzhouChina
| | - Jinwen He
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Sylvia White
- Department of PathologyYale University School of MedicineNew HavenCTUSA
| | - Yayi Xia
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| |
Collapse
|
10
|
Kaldau NC, Nedergaard NJ, Hölmich P, Bencke J. Adjusted Landing Technique Reduces the Load on the Achilles Tendon in Badminton Players. J Sports Sci Med 2022; 21:224-232. [PMID: 35719224 PMCID: PMC9157523 DOI: 10.52082/jssm.2022.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
Achilles tendon (AT) rupture is common among recreational male badminton players. We hypothesize that a landing technique following forehand jump strokes with the landing foot in a neutral position often performed by recreational players and occasionally by elite players may expose the AT to higher loads than a scissor kick jump (SKJ) technique with the leg/foot externally rotated. The study aimed to investigate if recreational players could reduce the load in the AT when adopting the SKJ technique compared to their habitual landing technique with the foot in a neutral position and secondarily to compare the AT force between recreational players and elite players. Ten recreational male players performed simulated jump strokes in a biomechanical laboratory using both their original technique and the SKJ technique traditionally used by elite players. For comparison reasons ten elite players performed SKJs. Landing kinematics and AT forces were captured and calculated using 3D movement analysis. The landing leg was more externally rotated in the recreational players' adjusted technique (78 ± 10 degrees, p < 0.001) compared to 22 ± 21 degrees in recreational players' original technique. The peak AT force of the recreational players was significantly higher for the original technique compared to the adjusted technique (68 ± 19 N/kg vs. 50 ± 14 N/kg, p = 0.005). Additionally, the peak AT forces observed during the recreational players' original technique was higher, though not significantly, than those observed for elite players (55 ± 11 N/kg, p = 0.017). / = 0.016 due to a Bonferroni correction. These findings indicate that recreational badminton players that normally land with the foot in a neutral position, may reduce their AT load by 25% when adopting the SKJ technique of elite players and land with the leg/foot in an externally rotated position.
Collapse
Affiliation(s)
- Niels Christian Kaldau
- Sports Orthopedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Niels Jensby Nedergaard
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| |
Collapse
|
11
|
Won Lee K, Bae JY, Ho BC, Kim JH, Seo DK. Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair. J Foot Ankle Surg 2022; 61:604-608. [PMID: 34785129 DOI: 10.1053/j.jfas.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/29/2018] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely. This study aimed to introduce our most accelerated functional rehabilitation protocol following surgery for acute Achilles tendon rupture and to review the results retrospectively. From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated. The mean time to be able to squat fully was 10 ± 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients). The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 ± 3.9 (6-24) and 23.3 ± 7.7 (8-40) weeks, respectively. The mean time to return to sports was 20.6 ± 5.2 (12-32) weeks. The major complication rate was 3.5% (one re-rupture and one tendon elongation). The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 ± 3.7 (20-38) and 79.3 ± 18.5 (20-98) points, respectively. The increase was significant (p < .01). In conclusion, immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results.
Collapse
Affiliation(s)
- Ki Won Lee
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Joo-Yul Bae
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Byeong Cheol Ho
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Joon Hee Kim
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Dong-Kyo Seo
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea.
| |
Collapse
|
12
|
Ghaddaf AA, Alomari MS, Alsharef JF, Alakkas E, Alshehri MS. Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials. Injury 2022; 53:1543-1551. [PMID: 35115168 DOI: 10.1016/j.injury.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Achilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early functional rehabilitation or cast immobilization. The aim of the present systematic review and meta-analysis was to provide an update about the role of early weightbearing (WB) versus late WB on the clinical outcomes of adults with acute ATR. METHODS We performed a systematic literature search in Web of Science, Ovid, Medline/PubMed, and CENTRAL. We included randomized controlled trials (RCTs) that compared early WB, defined as weight-bearing within 4 weeks of treatment, to late WB for individuals with acute (<14 days) ATR. We sought to evaluate the following outcomes: re-rupture rate, Achilles Tendon Rupture Score (ATRS), return to pre-injury sport activity, time to return to work, and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS A total of 9 RCTs that enrolled 1046 participants were deemed eligible. There was no significant difference between early WB and late WB in terms of re-rupture rate (RR=0.75, 95% CI 0.49 to 1.16), ATRS (SMD=0.06, 95% CI -0.03 to 0.16), return to pre-injury sport activity (RR=1.05, 95% CI 0.86 to 1.28), time to return to work (SMD=0.03, 95% CI -0.20 to 0.26), or adverse event rate (RR=1.87, 95% CI 0.53 to 6.63). CONCLUSION This meta-analysis shows no difference in the functional outcomes and patient-reported outcomes between early functional rehabilitation and cast immobilization for conservatively treat individuals with acute ATR.
Collapse
Affiliation(s)
- Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Mohammed S Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jawaher F Alsharef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Eyad Alakkas
- Department of Surgery/Orthopedic Section, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed S Alshehri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| |
Collapse
|
13
|
Carrigan M. Full Thickness Achilles Tendon Tears: Two Case Studies. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221079779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Achilles tendon is the largest and strongest tendon in the body. With increasing age and repetitive use, the Achilles tendon is more prone to injury, ranging from a mild injury to a full thickness tear. Achilles tendon injuries are one of the most common sporting injuries, and sonography may be the first imaging modality used to diagnose. Technologists must be familiar and able to recognize partial and full thickness tendon tears to assist in accurately diagnosing these injuries. Both the case studies provided demonstrate patients involved in sporting activities that resulted in complete Achilles tendon ruptures.
Collapse
Affiliation(s)
- Matthew Carrigan
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
14
|
Insertional versus non-insertional tendoachilles tears: a comparative analysis of various predisposing factors and outcome following a repair. INTERNATIONAL ORTHOPAEDICS 2022; 46:1009-1017. [PMID: 35165787 DOI: 10.1007/s00264-022-05337-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Association of tendon degeneration, pre-existing posterior heel pain, Haglund's bump, retrocalcaneal spur, and mode of injury varies for the insertional and non-insertional type of tendoachilles tears (TA). PURPOSE The study compares the various predisposing factors that determine the distinct type of TA tear and the outcome following a repair. METHODS This is a retrospective study of the patients who underwent tendoachilles repair during January 2012-June 2018. Patients above 18 years with a minimum follow-up of two years were included. Patients with calcaneal tuberosity avulsions, prior surgeries, and open injuries were excluded. Patients were divided into groups 1 (insertional tears (IT)) and 2 (non-insertional tears (NIT)), and further subdivided based on the tendon degeneration (as D-degenerative and N-normal sub types) from ultrasound findings. AOFAS score and predisposing factors like degeneration, posterior heel pain, Haglund's bump, spur, and mechanism of injury were compared between the groups. RESULTS The study included N = 146 with a mean age of 51.6 years and mean follow-up of 38.6 (range 24 to 96) months. IT associated with degeneration (IT-D) had a trivial fall as the predominant mechanism (P < 0.001). All patients had significant postoperative improvement of scores with no significant difference between the groups (P = 0.59) and subgroups (P = 0.27).75.34% had degenerative tendon, of which 64.5% were in the IT group and the rest in the NIT group (P = 0.02). 51.4% patients had a Haglund bump in the IT group and n.s. (P = 0.9). Forty-seven percent of patients had pre-existing posterior heel pain, 68% in IT and 32% in NIT (P = 0.04). Subgroup analysis revealed 65% of patients were in the IT-D subgroup (P < 0.001). CONCLUSION Predisposing factors like posterior heel pain, tendon degeneration, and trivial trauma have a strong propensity for insertional TA tear. In contrast, the prominence of Haglund's bump does not predispose to a distinct type of TA tears. The outcome following a surgical repair-yields good results with no difference between the two groups.
Collapse
|
15
|
Kage T, Sanada T, Iwaso H, Goto H, Fukai A, Yamagami R, Honda E, Uchiyama E. Morphology of Acute Achilles Tendon Rupture by Intraoperative Evaluation. J Foot Ankle Surg 2021; 60:1198-1203. [PMID: 34134918 DOI: 10.1053/j.jfas.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to clarify the morphology of acute Achilles tendon rupture (ATR) according to intraoperative evaluation. The morphology of 220 cases was evaluated retrospectively from intraoperative findings from June 2014 to December 2015. We noted 3 characteristics of rupture. First, we divided the ruptures into complete or partial type. Second, according to the level of rupture, we classified them into muscle-tendon junctional type, mid-substantial type, or calcaneal insertional avulsion type. Lastly, on the basis of the pattern of rupture, we divided them into transverse pattern, double-layer pattern, or Z-shaped pattern. All ruptured tendons were repaired with surgical procedures on the basis of the classification of rupture type or pattern. Of the total of 220 cases, 217 were complete ruptures (98.7%) and 3 partial ruptures (1.3%). Regarding the level of rupture, 5 cases were of the muscle-tendon junctional type (2.3%), 209 cases of the mid-substantial type (95%), and 6 cases of the calcaneal insertional avulsion type (2.7%). In terms of the pattern of rupture, there were 198 cases of the transverse pattern (90%), 10 cases of the double-layer pattern (4.5%), and 12 cases of the Z-shaped pattern (5.5%). There was significant gender difference only in the mid-substantial type. Although the morphology of a typical acute ATR was complete, of mid-substance type, and with transverse pattern, other types of ATR were recognized from the intraoperative investigation.
Collapse
Affiliation(s)
- Tomofumi Kage
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan.
| | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Hidetaka Goto
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Atsushi Fukai
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Ryota Yamagami
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Eisaburo Honda
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Eiji Uchiyama
- Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo, Japan
| |
Collapse
|
16
|
Biz C, Cerchiaro M, Belluzzi E, Bragazzi NL, De Guttry G, Ruggieri P. Long Term Clinical-Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig. ACTA ACUST UNITED AC 2021; 57:medicina57101073. [PMID: 34684110 PMCID: PMC8537444 DOI: 10.3390/medicina57101073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical-functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical-functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle-Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical-functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.
Collapse
Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Giacomo De Guttry
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| |
Collapse
|
17
|
Batista JP, Abdelatif NMN, Del Vecchio JJ, Diniz P, Pereira H. Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months' Follow-Up. J Foot Ankle Surg 2021; 59:927-937. [PMID: 32527698 DOI: 10.1053/j.jfas.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 02/03/2023]
Abstract
Acute Achilles tendon rupture can be treated either surgically or nonsurgically. The flexor hallucis longus (FHL) has been used successfully in patients with large chronic Achilles tendon defects. The aim of this study was to describe the clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a minimum follow-up of 18 months. Fifty-six male patients with an average age of 36.3 years who underwent endoscopic FHL transfer as a treatment for acute Achilles tendon ruptures were included. Follow-up was for a mean (± standard deviation) of 27.5 ± 7.29 months. At 18 months postoperatively, the Achilles tendon total rupture score mean was 95 ± 4.26, and the American Orthopaedic Foot and Ankle Society score was a mean of 96.4 ± 4.31. The median value for FHL tendon dynamometry on the surgical side was 95.72 (range 70.1 to 142), and 100.7 (range 68 to 161) for the nonoperated side. Mean ankle plantarflexion strength at 18 months was 19.19 ± 2.55 kg • m compared with the uninjured side of 19.27 ± 2.16 kg • m. Relative Achilles tendon resting angle showed a mean of -0.25° ± 2.43°. Magnetic resonance imaging performed at a minimum of 18 months postoperatively showed a homogeneous continuous Achilles tendon signal for 43 patients and heterogeneous signal intensity in 13 patients (23.21%). No patients reported any great toe complaints or symptomatic deficits of flexion strength. No neurovascular or skin complications were encountered. The current study demonstrated satisfactory and comparable results with minimal complications when using the endoscopic FHL tendon transfer in surgical management of acute Achilles tendon ruptures, compared with the currently used methods.
Collapse
Affiliation(s)
- Jorge Pablo Batista
- Head, Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Buenos Aires, Argentina; Head, Soccer Medical Department, Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
| | | | - Jorge Javier Del Vecchio
- Head, Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro. Hospital Universitario, Buenos Aires, Argentina; Professor, Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina
| | - Pedro Diniz
- Orthopaedic Surgeon, Hospital de Sant'Ana, Parede, Portugal; PhD Student, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Helder Pereira
- Orthopedic Surgeon, Orthopedic Department of Póvoa de Varzim, Ripoll y De Prado Sports Clinic, Murcia-Madrid, Spain; Orthopedic Surgeon, FIFA Medical Centre of Excellence; ICVS/3B's, PT Government Associate Laboratory, Porto, Portugal; Orthopedic Surgeon, ICVS/3B's, PT Government Associate Laboratory - Minho University, Braga, Portugal
| |
Collapse
|
18
|
Akoh CC, Fletcher A, Sharma A, Parekh SG. Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide. Foot Ankle Int 2021; 42:294-304. [PMID: 33148032 DOI: 10.1177/1071100720962493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. METHODS A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. RESULTS The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. CONCLUSION Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
| | | | | | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
19
|
Mansur NSB, Fonseca LF, Matsunaga FT, Baumfeld DS, Nery CADS, Tamaoki MJS. Achilles Tendon Lesions - Part 2: Ruptures. Rev Bras Ortop 2020; 55:665-672. [PMID: 33364642 PMCID: PMC7748929 DOI: 10.1055/s-0040-1702948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/07/2022] Open
Abstract
The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.
Collapse
Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Lucas Furtado Fonseca
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Fábio Teruo Matsunaga
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Daniel Soares Baumfeld
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Caio Augusto de Souza Nery
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| |
Collapse
|
20
|
Dai W, Leng X, Wang J, Hu X, Ao Y. Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. J Sci Med Sport 2020; 24:536-543. [PMID: 33388266 DOI: 10.1016/j.jsams.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare re-rupture rate, functional and quality-of-life outcomes, return to sports and work, complications, and resource use in patients treated non-surgically with different rehabilitation regimens for Achilles tendon rupture. DESIGN Systematic review and meta-analysis. METHODS We performed a systematic literature search in PubMed, Embase, Scopus and the Cochrane Library through May 2020 to identify randomized controlled trials (RCTs) that included patients treated non-surgically for Achilles tendon rupture. All analyses were stratified according to rehabilitation protocols. RESULTS Eight RCTs with a total of 978 patients were included. There was no significant difference about re-rupture rate (P=0.38), return to sports (P=0.85) and work (P=0.33), functional outcome (P=0.34), quality of life (P=0.50), and complication rate (P=0.29) between early weight bearing with functional ankle motion and traditional ankle immobilisation with non-weight bearing. Similarly, no significant difference in re-rupture rate (P=0.88), return to sports (P=0.45) and work (P=0.20), functional outcome (P=0.26), and complication rate (P=0.49) was seen between ankle immobilisation with non-weight bearing and early weight bearing without functional ankle motion. CONCLUSIONS Traditional ankle immobilisation with non-weight bearing was not found to be superior to early weight bearing with or without functional ankle motion for patients treated non-surgically for Achilles tendon rupture. Clinicians may consider early weight bearing in functional brace as a safe and cost-effective alternative to non-weight bearing with plaster casting.
Collapse
Affiliation(s)
- Wenli Dai
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, People's Republic of China
| | - Xi Leng
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, People's Republic of China
| | - Jian Wang
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, People's Republic of China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, People's Republic of China.
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, People's Republic of China.
| |
Collapse
|
21
|
Nilsson N, Nilsson Helander K, Hamrin Senorski E, Holm A, Karlsson J, Svensson M, Westin O. The economic cost and patient-reported outcomes of chronic Achilles tendon ruptures. J Exp Orthop 2020; 7:60. [PMID: 32748273 PMCID: PMC7399724 DOI: 10.1186/s40634-020-00277-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose While most Achilles tendon ruptures are dramatic and diagnosed quickly, some are missed, with a risk of becoming chronic. A chronic Achilles tendon rupture is defined as a rupture that has been left untreated for more than 4 weeks. By mapping the health economic cost of chronic Achilles tendon ruptures the health-care system might be able to better distribute resources to detect these ruptures at an earlier time. Method All patients with a chronic Achilles tendon rupture who were treated surgically at Sahlgrenska University Hospital or Kungsbacka Hospital between 2013 and 2018 were invited to participate in the study. The patients were evaluated postoperatively using the validated Achilles tendon Total Rupture Score (ATRS). The health-care costs were assessed using clinical records. The production-loss costs were extracted from the Swedish Social Insurance Agency. The cost of chronic Achilles tendon ruptures was then compared with the cost of acute ruptures in a previous study by Westin et.al. Results Forty patients with a median (range) age of 66 (28–86) were included in the study. The mean total cost (± SD) for the patients with a chronic Achilles tendon rupture was 6494 EUR ± 6508, which is 1276 EUR higher than the mean total cost of acute ruptures. Patients with chronic Achilles tendon ruptures reported a mean (min-max) postoperative ATRS of 73 (14–100). Conclusion Missing an Achilles tendon rupture will entail higher health-care costs compared with acute ruptures. Health-care resources can be saved if Achilles tendon ruptures are detected at an early stage.
Collapse
Affiliation(s)
- Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Holm
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mikael Svensson
- Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
22
|
Nascimento LDES, Nicolau RA, Maia Filho ALM, Nascimento KFES, Santos JZLV, Sousa RCD, Carvalho LFM, Viana VGF. Effect of low intensity photobiomodulation associated with norbixin-based poly (hydroxybutyrate) membrane on post-tenotomy tendon repair. In vivo study. Acta Cir Bras 2020; 35:e202000303. [PMID: 32490900 PMCID: PMC7357841 DOI: 10.1590/s0102-865020200030000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/15/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: To evaluate the in vivo response of photobiomodulation therapy associated with norbixin-based poly(hydroxybutyrate) membrane (PHB) in tenotomized calcaneal tendon. Methods: Thirty rats were randomly allocated to six groups (n=5 each): LED groups (L1, L2 and L3) and membrane + LED groups (ML1, ML2 and ML3). The right calcaneal tendons of all animals were sectioned transversely and were irradiated with LED daily, one hour after surgery every 24 hours, until the day of euthanasia. At the end of the experiments the tendons were removed for histological analysis. Results: The histological analysis showed a significant reduction in inflammatory cells in the ML1, ML2 and ML3 groups (p=0.0056, p=0.0018 and p<0.0001, respectively) compared to those in the LED group. There was greater proliferation of fibroblasts in the ML1 (p<0.0001) and L3 (p<0.0001) groups. A higher concentration of type I collagen was also observed in the ML1 group (p=0.0043) replacing type III collagen. Conclusion: Photobiomodulation in association with norbixin-based PHB membrane led to control of the inflammatory process. However, it did not favor fibroblast proliferation and did not optimize type I collagen formation in the expected stage of the repair process.
Collapse
|
23
|
Lo Torto F, Kaciulyte J, Marcasciano M, Casella D, Bernetti A, Mangone M, Agostini F, Ciudad P, Fioramonti P, Ruggiero M, Ribuffo D, Carlesimo B. Peroneus Brevis flap in Achilles tendon reconstruction. Clinical, radiological and functional analysis. Foot Ankle Surg 2020; 26:218-223. [PMID: 30837207 DOI: 10.1016/j.fas.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps. METHODS Eight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients' outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery. RESULTS Effective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests' results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients' quality of life. CONCLUSIONS In the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site's low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial.
Collapse
Affiliation(s)
- Federico Lo Torto
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Juste Kaciulyte
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy.
| | - Marco Marcasciano
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Donato Casella
- Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest", Italy
| | - Andrea Bernetti
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Massimiliano Mangone
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Francesco Agostini
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Pedro Ciudad
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Paolo Fioramonti
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Marco Ruggiero
- Policlinico Luigi Di Liegro, Via dei Badoer, Rome, Italy
| | - Diego Ribuffo
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Bruno Carlesimo
- Department of Plastic Surgery, Clinica Mater Dei, Rome, Italy
| |
Collapse
|
24
|
Steinmann S, Pfeifer CG, Brochhausen C, Docheva D. Spectrum of Tendon Pathologies: Triggers, Trails and End-State. Int J Mol Sci 2020; 21:ijms21030844. [PMID: 32013018 PMCID: PMC7037288 DOI: 10.3390/ijms21030844] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
The biggest compartment of the musculoskeletal system is the tendons and ligaments. In particular, tendons are dense tissues connecting muscle to bone that are critical for the integrity, function and locomotion of this system. Due to the increasing age of our society and the overall rise in engagement in extreme and overuse sports, there is a growing prevalence of tendinopathies. Despite the recent advances in tendon research and due to difficult early diagnosis, a multitude of risk factors and vague understanding of the underlying biological mechanisms involved in the progression of tendon injuries, the toolbox of treatment strategies remains limited and non-satisfactory. This review is designed to summarize the current knowledge of triggers, trails and end state of tendinopathies.
Collapse
Affiliation(s)
- Sara Steinmann
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
| | - Christian G. Pfeifer
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Medical Biology, Medical University-Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
- Correspondence: ; Tel.: +49 941 943-1605
| |
Collapse
|
25
|
Hackenberg RK, Täger S, Prangenberg C, Kabir K, Welle K. Reconstruction of Complicated Achilles Tendon Ruptures with Soft Tissue Defects - a Systematic Overview and Development of a Treatment Algorithm. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:314-322. [PMID: 31958851 DOI: 10.1055/a-1073-8516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Achilles tendon ruptures are among the most common ruptures of large tendons. Due to the vulnerable soft tissue there is a high risk of soft tissue defects. The combination of Achilles tendon ruptures and soft-tissue defects remains a challenge for the surgeon. Despite different treatment options there is a lack of structured treatment recommendation. By means of a systematic literature review and experience from our own clinic standard, an overview of the stepwise treatment options is presented. A treatment algorithm for reconstructive measures of Achilles tendon ruptures accompanied by soft-tissue defects according to the length of defect of the Achilles tendon, the size of the soft-tissue defect and patient-individual factors is developed. This is intended to serve the surgeon as a basis for decision making prior to application of therapy.
Collapse
Affiliation(s)
- Roslind Karolina Hackenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Stefan Täger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| |
Collapse
|
26
|
Bisaccia M, Rinonapoli G, Meccariello L, Bisaccia O, Ceccarini P, Rollo G, Ibáñez-Vicente C, Cervera-Irimia J, Sánchez-Sánchez F, Ribes-Iborra A, Gomez-Garrido D, Caraffa A. Validity and Reliability of Mini-Invasive Surgery Assisted by Ultrasound in Achilles Tendon Rupture. Acta Inform Med 2019; 27:40-44. [PMID: 31213742 PMCID: PMC6511267 DOI: 10.5455/aim.2019.27.40-44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: The surgical treatment for Achilles tendon rupture has become very popular in the last years, because of the good outcomes and the low re-rupture rate. Aim: The aim of this study is to compare the results between open surgery and percutaneous ultrasound-assisted surgery. Methods: All patients who underwent an Achilles tendon surgical repair in the last 3 years were included, resulting in a total of 56 patients (40 M and 16 F) with an average age of 53 years. Of these patients, 36 were treated with an open suture, while 20 with a mini invasive ultrasound assisted suture. At a minimum follow-up of one year, patients were evaluated echografically, using both the Achilles Tendon Rupture Total score (ATRS) and the McComis score, and performing the ultrasounds bilaterally to assess both the structure and the diameter of tendons. Results: Both groups of patients showed an average ATRS score >80. The McComis score was 54.18 vs. 56.25 (p>0.05). Plantar flexion and dorsal flexion work were not similar (p>0.05). On average, the calf circumference of the operated side was decreased compared to the healthy side between the groups (p>0.05). The thickness of the operated tendons evaluated with ultrasound measurement compared to the average tendon, (p <0.05). Conclusion: The ultrasound-assisted tenorrhaphy is a reliable treatment with good clinical and functional outcomes; anyway, the percutaneous technique and the open surgery show similar results.
Collapse
Affiliation(s)
- Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Giuseppe Rinonapoli
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, Lecce, Italy
| | - Olga Bisaccia
- Section of Diagnostic Imaging, "S. Carlo Hospital", Potenza, Italy
| | - Paolo Ceccarini
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, Lecce, Italy
| | | | - Javier Cervera-Irimia
- Orthopaedic and Trauma Surgeon "Hospital General de Villalba", ColladoVillalba, Spain
| | - Felix Sánchez-Sánchez
- Division of Orthopedics and Trauma Surgery, "ComplejoHospitalario Universitario de Toledo", Toledo, Spain
| | - Angela Ribes-Iborra
- Department of Intensive Care, "Hospital Corporacion Sanitaria Parc Taulì" Sabadell, Barcellona, Spain
| | - David Gomez-Garrido
- Orthopaedic and Trauma Surgeon "Hospital General de Villalba", ColladoVillalba, Spain
| | - Auro Caraffa
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| |
Collapse
|
27
|
Zhang H, Liu PZ, Zhang X, Ding C, Cui HC, Ding WB, Wang RK, Wu DJ, Wei Q, Qin S, Wu XL, Tong DK, Wang GC, Tang H, Ji F. A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and "circuit" suture technique. J Orthop Surg Res 2018; 13:198. [PMID: 30097054 PMCID: PMC6086049 DOI: 10.1186/s13018-018-0895-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022] Open
Abstract
Background Traditional incision repair and minimally invasive repair for acute Achilles tendon repair have limitations. This study aimed to present our series of 23 patients with acute Achilles tendon rupture that was repaired using two small incisions to assist the anchor repair of the tear and a new “circuit” suture technique. Methods This was a retrospective study of 23 patients with acute Achilles tendon rupture treated with the new technique at Changhai Hospital between January 2015 and December 2016 and followed up for 14–33 months. Clinical outcome was assessed using the AOFAS, Leppilahti, and Arner-Lindholm scores. Complications, range of motion (ROM), and time to return to work and light sport activity were assessed. Results The AOFAS score was 85–96 at 3 months and 92–100 at 12 months. The 3-month ROM was 27°–37°, and the 12-month ROM was 36°–48°. The Leppilahti score was 85–95 at 3 months and 90–100 at 12 months. The recovery time of the patients was 10–18 weeks. The postoperative recovery time to exercise was 16–24 weeks. There was only one case of deep venous thrombosis. According to the Arner-Lindholm assessment criteria, patient outcomes were rated as excellent in 20 (87.0%) cases, good in three (13.0%) cases, and poor in 0 cases. The excellent-to-good rate was 100%. Conclusion The limited-open procedure combined with a single-anchor and “circuit” suture technique could be used to repair torn Achilles sites, with a low occurrence of complications. This new and minimally invasive technique could be an alternative in the management of acute Achilles tendon rupture.
Collapse
Affiliation(s)
- Hao Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Pei-Zhao Liu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xin Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Chen Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao-Chen Cui
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Wen-Bin Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Ren-Kai Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Jiang Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Qiang Wei
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Sheng Qin
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xue-Lin Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Ke Tong
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Guang-Chao Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao Tang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
| | - Fang Ji
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
| |
Collapse
|
28
|
Ye YJ, Zhou YQ, Jing ZY, Liu YY, Yin DC. Electrospun Heparin-Loaded Core-Shell Nanofiber Sutures for Achilles Tendon Regeneration In Vivo. Macromol Biosci 2018; 18:e1800041. [PMID: 29806211 DOI: 10.1002/mabi.201800041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/17/2018] [Indexed: 12/31/2022]
Abstract
Achilles tendon reconstruction surgery is the primary clinical method for repairing acute Achilles tendon ruptures. However, the efficacy of the postoperative healing process and the recovery of physiological function are inadequate. This study examines the healing mechanism of ruptured rat Achilles tendons seamed with heparin-loaded core-shell fiber sutures fabricated via near-field electrospinning. High-heparin-concentration sutures (PPH3.0) perform better than the low-heparin-concentration sutures and commercial sutures (CSs). The PPH3.0 suture recruits fewer inflammatory cells and shows good histocompatibility in peritoneal implantation experiments. Staining of the Achilles tendon rupture repair zone demonstrates that a high heparin concentration in sutures reduces immune-inflammatory responses. Immunohistochemical analysis reveals that the transforming growth factor-β staining scores of the PPH3.0 sutures are not significantly different from those of the corresponding control group but are significantly different from those of the CSs and non-heparin-loaded-suture groups. According to vascular endothelial growth factor (VEGF) analysis, the concentration of VEGF in the group treated with the PPH3.0 suture increases by 37.5% compared with that in its control group. No significant difference in tension strength is observed between the PPH3.0 group and healthy Achilles tendons. These findings illustrate that this novel method effectively treats Achilles tendon rupture and promotes healing and regeneration.
Collapse
Affiliation(s)
- Ya-Jing Ye
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Ya-Qing Zhou
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Zhuo-Yuan Jing
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Yang-Yang Liu
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Da-Chuan Yin
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072, China
| |
Collapse
|
29
|
Liechti DJ, Moatshe G, Backus JD, Marchetti DC, Clanton TO. A Percutaneous Knotless Technique for Acute Achilles Tendon Ruptures. Arthrosc Tech 2018; 7:e171-e178. [PMID: 29552483 PMCID: PMC5851437 DOI: 10.1016/j.eats.2017.08.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023] Open
Abstract
Achilles tendon ruptures are a common tendon injury, usually occurring in middle-aged men during recreational sporting activities. Both nonoperative and operative management are employed to treat these injuries. Several operative treatments are described in the literature, including percutaneous Achilles repair, mini-open repair, and open repair. Open Achilles repair is associated with higher rates of impaired wound healing and infection, whereas minimally invasive techniques have been reported to have an increased risk of iatrogenic sural nerve injury. More recently, low complication rates, improved cosmetic appearance, reduced operating times, and improved clinical outcomes have been reported for the percutaneous Achilles repair technique. In this Technical Note, we present our preferred technique using the Percutaneous Achilles Repair System (Arthrex, Naples, FL), which has been reported to have minimal wound and nerve complications, and early return to activity.
Collapse
Affiliation(s)
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jonathon D Backus
- Cornerstone Orthopaedics and Sports Medicine, Louisville, Colorado, U.S.A
| | | | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A
| |
Collapse
|
30
|
Lim CS, Lees D, Gwynne-Jones DP. Functional Outcome of Acute Achilles Tendon Rupture With and Without Operative Treatment Using Identical Functional Bracing Protocol. Foot Ankle Int 2017; 38:1331-1336. [PMID: 28891323 DOI: 10.1177/1071100717728687] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the functional results of operative and nonoperative treatment of acute Achilles tendon rupture using an identical rehabilitation program of functional bracing. METHODS Over a 10-year period, 200 patients (99 operative, 101 nonoperative) aged between 18 and 65 years were treated at our institution's physiotherapy department after acute Achilles tendon rupture. There were 132 patients (62 operative, 70 nonoperative) available for a minimum 2-year follow-up (average 6.5 years; range, 2-13 years). Functional outcome was assessed using the Achilles tendon total rupture score (ATRS). RESULTS With the numbers available, no significant difference could be detected in ATRS between operative (mean 84.8, median 90) and nonoperative groups (mean 85.3, median 91; P = 0.55). No significant difference could be detected in ATRS between male and female patients however treated ( P = 0.30) or between patients younger and older than 40 years at time of injury ( P = 0.68). There was no correlation between ATRS score and age at injury in all patients (ρ = -0.0168, P = 0.85). In male patients, there was a weak trend with older patients at follow-up having better scores (ρ = 0.21, P = 0.069). However, among female patients, there was a significant negative correlation between ATRS scores and increasing age (ρ = -0.29, P = 0.03). Logistic regression analysis failed to show any significant effect of age at rupture, gender, or mode of treatment on ATRS. CONCLUSIONS This study showed no significant difference detectable in ATRS between operative and nonoperative patients in the treatment of acute Achilles tendon ruptures using an identical rehabilitation program with functional bracing. LEVEL OF EVIDENCE Level II, prospective comparative study.
Collapse
Affiliation(s)
- Che Siu Lim
- 1 Whangarei Hospital, Orthopaedic Outpatients, Whangarei, New Zealand
| | - David Lees
- 2 Waikato District Health Board, Hamilton, New Zealand
| | - David P Gwynne-Jones
- 3 Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,4 Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
31
|
Kokulu K, Akça HŞ. The Kager's Fat Pad Sign. J Emerg Med 2017; 53:760-761. [DOI: 10.1016/j.jemermed.2017.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/29/2017] [Accepted: 08/08/2017] [Indexed: 11/25/2022]
|
32
|
Carmont MR, Zellers JA, Brorsson A, Olsson N, Nilsson-Helander K, Karlsson J, Silbernagel KG. Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study. Orthop J Sports Med 2017; 5:2325967117723347. [PMID: 28856168 PMCID: PMC5571770 DOI: 10.1177/2325967117723347] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively). Conclusion: Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.
Collapse
Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, United Kingdom.,Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer A Zellers
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicklas Olsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Kungsbacka Hospital, Kungsbacka, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW The purpose of this study is to review the current literature of Achilles tendon injuries, specifically chronic tendinopathy and acute ruptures in regard to etiology, diagnosis, treatment options, and outcomes. RECENT FINDINGS The incidence of Achilles tendon injuries is increasing, but the necessity for surgical intervention is decreasing due to improved conservative therapies, which may provide comparable outcomes without the implied surgical risk. If surgery is undertaken, no difference has been noted between open and minimally invasive techniques. The majority of patients are able to return to pre-injury level of activity, with the elite athlete as an unfortunate exception. Achilles injuries can be devastating injuries, but if addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality implemented. Further research is needed into the etiology, potential preventative measures, and longer-term outcomes of the different treatment options for wide range of Achilles pathology.
Collapse
Affiliation(s)
- Anthony C Egger
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 2049 E 100th St, Desk A40, Cleveland, OH, 44195, USA.
| | - Mark J Berkowitz
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 2049 E 100th St, Desk A40, Cleveland, OH, 44195, USA
| |
Collapse
|